https://sig2perspectives.pubs.asha.org/article.aspx?articleid=1773582Service Delivery for People Confronting Aphasia: Some Thoughts and Practical Suggestions in Troubled TimesService delivery for people confronting aphasia in America bears little resemblance to what it was a decade ago, and perhaps more importantly, to the foundation upon which it was built decades prior (Porch, 1967; Schuell, 1965; Wepman, 1951). Gone are extended periods of intense stimulation aimed at optimal return of ...1999-12-01T00:00:00ArticleJon G. Lyon

Article | December 01, 1999

Service Delivery for People Confronting Aphasia: Some Thoughts and Practical Suggestions in Troubled Times

Service delivery for people confronting aphasia in America bears little resemblance to what it was a decade ago, and perhaps more importantly, to the foundation upon which it was built decades prior (Porch, 1967; Schuell, 1965; Wepman, 1951). Gone are extended periods of intense stimulation aimed at optimal return of language and communication. With these has come the elimination of fee-for-ser-vice plans that previously sanctioned treatment as long as patient performance yielded notable gains on standardized measures.

In its place, service delivery has become an entirely different entity with an entirely different mission and focus. In today’s managed care environment, treatment provides only a “jump start” to select portions of communicative breakdown, that is, those that hold promise for quick return and functional value in daily life (Elman, 1998). Because the timeline and frequency for such services is now gauged in days and weeks, not months or years, more and more consumers are slipping in and out of acute and intermediate care settings with little or no service at all (Rothi, 1996; Simmons-Mackie, in press). Even when aphasia is identified and treated, the brevity of services requires that we devote as much time preparing the consumer to cope with what lies immediately ahead as time addressing what might ultimately “work,” if adequately facilitated.